Affidavit of Name Change

State of
County of

I, , being duly sworn, depose and state the following:

  1. My current full legal name is .
  2. My previous name was .
  3. I was born on in .
  4. I am requesting this name change for the following reason:
  5. I affirm that this name change is not for any fraudulent purpose and that I am not seeking to avoid any debts or obligations.

I make this affidavit to declare that I am now known as and request that all my records and identification reflect my new legal name.

Signature
Date
Notary Public